153

PREDICTIVE FACTORS OF A COMPLEX EVOLUTION IN PATIENTS WITH ESOPHAGEAL ATRESIA

J Castilloux, A Noble, C Bélanger, C Faure
Department of Pediatric Gastroenterology, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec

BACKGROUND: Despite the major improvement in the survival rate of patients with esophageal atresia and tracheoesophageal fistula (EA-TEF), the morbidity associated with this condition remains high. Given this, the aim of our study was to identify early predictive factors of serious complications during the 1st year of life (short term) and after one year of age (long term) in these patients.
METHODS: We retrospectively reviewed the charts of all EA-TEF children born between January 1990 and May 2005. Included cases were operated at Hôpital Sainte-Justine and had a minimum one year of follow up data available. Variables analyzed were the type of atresia, neonatal history, details of the surgery and early post-operative period. A complicated evolution was defined as the occurrence of at least one of severe gastroesophageal reflux (presence of moderate to severe esophagitis or need of surgery), esophageal stenosis needing dilation, recurrent fistula, growth problems, need of a gastrostomy, severe tracheomalacia requiring aortopexy or tracheostomy, chronic respiratory disease and need of an upper endoscopy for esophageal foreign body impaction.
RESULTS: 131 of 153 EA-TEF patients fulfilled our inclusion criteria. 51% were female. Mean gestational age was 37.1 weeks (29-42 wks) and mean birth weight was 2582g (1050-4334g). 61% had a complicated evolution before one year of age and 56% after one year. Twin pregnancy, type A and B atresia, long gap atresia, gastric interposition, pneumothorax, anastomotic leak, chylothorax and intubation => five days were all almost exclusively found in the complicated groups (short and long term). In addition, multiple logistic regression demonstrated that a birth weight less than 2500g (OR 3.6; 95%CI 1.3-10.3) and a hospitalization => 30 days (OR 11.1; 95%CI 2.6-46.7) predicted a complex evolution in the first year of life. Peri-operative complications and need of gavages in the first month influenced the length of hospitalization. After one year of age, only a complicated evolution in the first year of life was predictive of a continued complicated evolution (OR 2.2; 95%CI 1.0-4.6).
CONCLUSION: In children with EA-TEF, we found a number of variables predictive of a high risk of morbidity during the first year of life. Using these variables to identify EA-TEF children at higher risk of complications may allow us to modify their medical management and reduce their long term morbidity.
Supported in part by a grant from Abbott Laboratories

PREVIOUS NEXT